Preferences for Feeding Tube Use and Their Determinants Among Cognitively Intact Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Abstract

Introduction: Standard advance care planning practice is yet to be established in Mainland, China, and little is known about feeding tube preferences among Chinese nursing home residents. The purpose of the study was to examine preferences for feeding tube use and its predictors among frail and cognitively competent nursing home residents in Wuhan, China. Method: A cross-sectional sample of 682 nursing home residents were interviewed face-to-face using a structured questionnaire from 2012 to 2014. Results: A total of 54.5% of participants would accept feeding tube. Participants who reported greater quality of life (odds ratio [OR] = 2.67), having health insurance (OR = 2.09) were more willing to accept feeding tube. Participants with greater impairment in physical health (OR = 0.94) were less willing to accept it. Discussion: Health care professionals need to routinely assess nursing home residents’ feeding tube preferences. It is imperative to consider sociocultural perspectives in understanding Chinese older adults’ decision making for end-of-life care.

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

“…Of the 15 observational quantitative studies, five [38][39][40]45,47] were conducted in North America, seven [27,[32][33][34][35][36]44] in Europe and three [28,31,43] in Asia. The studies were performed between 1992 and 2020 and mostly in an outpatient setting.…”

“…The only quantitative non-randomized study [29] had low RoB. The quality of the 15 quantitative descriptive studies [27,28,[31][32][33][34][35][36][38][39][40][43][44][45]47] varied, with eleven studies [27,[31][32][33][34][35][36][38][39][40]44] scoring high because of a high participant non-response bias, three studies [31,40,44] not providing enough information to assess representativeness, and one study [31] not providing enough information to assess whether the employed measurements were appropriate. The three mixed methods studies [26,30,42] also scored low.…”

“…Among the included studies, 19 [26][27][28][29][31][32][33][34][36][37][38][39][40][42][43][44][45][46][47] reported data on willingness to receive LSTs; 14 reported data on specific LSTs such as cardiopulmonary resuscitation (CPR) [26,[31][32][33][34]36,38,40,42,47], mechanical ventilation (MV) [31][32][33][34][36][37][38]42,45] via endotracheal intubation (ETI) [27] or non-invasively (NIV) [27], use of feeding tubes [38,42,43], blood transfusion [38], dialysis [42,47] and implantable cardioverter defibrillator (ICD) withdrawal [46]. Three studies [27,…”

“…Four studies [38,42,43,46] assessed willingness to receive other LSTs (Table 3). Lee et al [38] found that in their present state and under every scenario that was presented, intravenous therapy, blood transfusions and nasogastric tubes were accepted by 93%, 89% and 52% of patients with multimorbidity respectively.…”

“…Although most participants indicated a preference, a small group reported being "unsure". Ni et al [43] reported that more than half the participating Chinese nursing home residents expressed a preference for the possible use of a feeding tube in case of severe cognitive impairment or even a life-threatening condition in which tube feeding could only help to sustain life but not result in a return to current health. The reasons for the willingness to accept the use of a feeding tube were "I should try when there is a chance" (84%) and "desire to live longer" (10%); reasons given for rejecting a feeding tube included "lived life long enough" (39%) and "doubts about the effectiveness of LST" (30%).…”